ENT and Allergy Associates, LLC

Appointments & Registration Forms

Welcome

 

Ear, Nose & Throat (ENT): the Areas of the Specialty

Allergy

Medical Articles and Links

 

 Directions and Hours

 Appointments and Registration Forms

 Contact Us

Welcome to our practice.  Please contact us to schedule an appointment.

We ask all new patients to our practice to complete a few forms that help us provide you the best of service and care.  To download these forms, just click below:

   Billing Information Form

   Initial Medical History Form

   Cosmetic Interest Questionnaire

Please bring the completed forms with you and return them to the receptionist upon your arrival.  You must bring in all of your insurance cards.  In addition, any co-pay or deductible required by your health plan must be paid at the time of your visit. 

We also suggest that you become familiar with our Financial Policy Statement  This document explains about insurance and your responsibilities to ensure that we help you enjoy the full benefit of that insurance.

For those who have time constraints and prefer on-line booking, at this time we include on-line scheduling for cosmetic consultations with Dr. Levine or hearing tests with Ms. Schary.  Click the icon below to see this feature.

We use every effort to accommodate your needs in scheduling appointments. Please help us serve you better by keeping scheduled appointments. With the large volume of patients whom we serve, if you need to cancel your appointment, please do so no less than 24 hours before, barring any emergency, so we may make your appointment time available to others on our wait list. If you are unable to cancel your appointment without notifying us a missed appointment fee of one hundred dollars will be assessed.

 

HIPAA Notice of Privacy Practices

Drug Authorization Policy

 

ENT and Allergy Associates, LLC
160 Hawley Lane, Suite 202, Trumbull, CT 06611
tel  (203) 380-3707     fax (203) 380-3711
 

Copyright © 2008 ENT and Allergy Associates, LLC